Symptoms of Little Value for Early Detection

Researchers assessed the predictive value of certain symptoms, including abdominal pain or bloating and urinary frequency, which were cited in a recent consensus statement as a way to diagnose ovarian cancer earlier.

The researchers conducted in-person interviews with 812 patients aged 35 to 74 years who had epithelial ovarian cancer that was diagnosed from 2002 through 2005. They compared the results from these case patients with results from interviews with 1,313 population-based control subjects—women who did not have ovarian cancer. The researchers assessed the sensitivity, specificity, and positive predictive value of a proposed symptom index and of symptoms included in the consensus recommendation.

Symptoms appeared in most case patients only about five or fewer months before diagnosis. Women with early-stage ovarian cancer were somewhat less likely to have symptoms (except nausea) than those with late-stage cancer. The estimated positive predictive value of the symptoms was 0.6 percent, one percent overall and less than 0.5 percent for early-stage disease. The authors conclude that 100 symptomatic women would need to be evaluated to detect one woman with ovarian cancer.

"The low positive predictive value of symptoms to detect ovarian cancer—particularly at an early stage—argues for a cautious approach to the use of symptom patterns to trigger extensive medical evaluation for ovarian cancer," the authors write.